One moment please...

PLEASE READ 

MAX'S PARTNERS WITH PEACE OF MIND DOG RESCUE'S "HELPING PAW PROGRAM."

YOU DO NOT NEED TO APPLY TO BOTH PROGRAMS. IF THERE IS A NEED, WE WILL SHARE YOUR APPLICATION WITH POMDR.

Please wait for a confirmation page to come up to confirm receipt of your application. If you do not see this page, please look for notes about missed fields. If you choose to email documentation to admin@maxshelpingpaws.org rather than uploading through this application, that will delay processing of your application.

CLIENT APPLICATION FOR SUPPORT

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Need to see a Vet/Don't know what's wrong = DIAGNOSTICS; Urgent/Emergency short term need = Critical Care - Short Term; Longer Term support of illness under doctor's care - Continued Care
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* Financial assistance has a limit of assistance for one pet/one situation/one family/one-year
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PET OWNER & SPOUSE/PARTNER/PET CO-OWNER INFORMATION

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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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First Name
Last Name
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PET INFORMATION

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(If you do not have a regular veterinarian, explain why not here)
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Provide as much detail as possible such as how this illness or injury occurred, why you are applying for assistance

HOUSEHOLD FINANCIAL INFORMATION

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For CalFresh/PGE/AT&T and CHIP, you will be asked to submit proof of participation in one.
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Your application cannot be processed until this is received.




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Please note we are not pay the entire cost of treatment. As a pet owner you are expected to incur some costs for the care of your pet.
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DOCUMENTATION/APPLICATION SUPPORT - REQUIRED (ID, PROOF OF FINANCIAL NEED, PET PHOTO) 

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Ideally LANDSCAPE Orientation (Camera turned on side)
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You must submit either through form or by sending photo of your ID/DL to admin@maxshelpingpaws.org

Your application cannot be processed until this is received, unless you have shown proof of inclusion in CALFRESH/PGE REACH/CHIP or AT&T LIFELINE.



(see accepted options noted in application)


I UNDERSTAND AND AGREE THAT:

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I accept and approve the above. If I receive assistance, I consent to use of my pet’s name, image & story by MHPF for website, PR, and other marketing purposes, AND I will cooperate with MHPF to schedule photos, interviews or video as necessary for their use.

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